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Published on: November 9, 2018
The relation between Glasgow Coma Scale score and later cerebral atrophy in paediatric traumatic brain injury
Alokananda Ghosh1, Elisabeth A Wilde, Jill V Hunter
1E.B. Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, TX, USA.
Insights
Lower initial Glasgow Coma Scale (GCS) scores in children with traumatic brain injury (TBI) predict increased odds of developing chronic cerebral atrophy. This finding aids in assessing TBI severity and long-term outcomes.
Area of Science:
- Pediatric Traumatic Brain Injury Research
- Neuroimaging and Neuropathology
- Quantitative Magnetic Resonance Imaging (QMRI)
Background:
- Traumatic Brain Injury (TBI) in children can lead to long-term neurological deficits.
- Assessing injury severity and predicting outcomes in pediatric TBI is crucial for patient management.
- The Glasgow Coma Scale (GCS) is a standard measure of acute brain injury severity.
Purpose of the Study:
- To investigate the relationship between initial Glasgow Coma Scale (GCS) scores and the development of cerebral atrophy in children with TBI.
- To utilize Quantitative Magnetic Resonance Imaging (QMRI) to assess cerebral atrophy at 4 months post-injury.
- To establish the predictive value of initial GCS scores for chronic cerebral atrophy in pediatric TBI.
Main Methods:
- A probability model was developed using QMRI data from 45 pediatric patients with TBI and 41 orthopedic controls.
- Initial GCS scores were correlated with neuroimaging findings, including ventricle-to-brain ratio (VBR) and white matter percentage.
- Logistic regression models, informed by normative QMRI data, were employed to assess predictive accuracy.
Main Results:
- Each one-point decrease in initial GCS score was associated with a 24% increase in the odds of an abnormal VBR.
- A one-point drop in GCS score correlated with a 27% increase in the odds of reduced white matter percentage.
- Lower initial GCS scores were confirmed as significant predictors of later cerebral atrophy.
Conclusions:
- The initial Glasgow Coma Scale (GCS) score is a valuable prognostic indicator in pediatric TBI.
- GCS scores predict not only cognitive recovery and functional outcomes but also subsequent parenchymal changes.
- This study supports the use of initial GCS scores to guide the assessment of chronic cerebral atrophy risk in pediatric TBI patients.
Primary Objective:
To examine initial Glasgow Coma Scale (GCS) score and its relationship with later cerebral atrophy in children with traumatic brain injury (TBI) using Quantitative Magnetic Resonance Imaging (QMRI) at 4 months post-injury. It was hypothesized that a lower GCS score would predict later generalized atrophy. As a guide in assessing paediatric TBI patients, the probability of developing chronic cerebral atrophy was determined based on the initial GCS score.
Methods And Procedures:
The probability model used data from 45 paediatric patients (mean age = 13.6) with mild-to-severe TBI and 41 paediatric (mean age = 12.4) orthopaedically-injured children.
Results:
This study found a 24% increase in the odds of developing an abnormal ventricle-to-brain ratio (VBR) and a 27% increase in the odds of developing reduced white matter percentage on neuroimaging with each numerical drop in GCS score. Logistic regression models with cut-offs determined by normative QMRI data confirmed that a lower initial GCS score predicts later atrophy.
Conclusion:
GCS is a commonly used measure of injury severity. It has proven to be a prognostic indicator of cognitive recovery and functional outcome and is also predictive of later parenchymal change.
